Tuesday, April 14, 2009

CGH vs Microarray

Yesterday was the follow-up with Dr. G. Neither Magic nor I felt good coming out of it. I did get my question answered about the difference between the two clinical trials of genetic testing that BigShotFertilityClinic is doing. We do qualify, but there is a catch.

Both CGH (Comparative Genomic Hybridization) and microarray are two types of microarray genetic testing that looks at all 23 of the human chromosomes. First, the difference between CGH and microarray are that they are done at two different labs. BigShotClinic switches between the two depending on which one is having better quality control and less "no results" at the time. They make these decisions weekly. Therefore, you don't know which one you will be doing until you start your stims. CGH amplifies all 23 chromosomes and tests them where as microarray tests parts of the sequences on all 23 chromosomes instead of all sequences of the 23 chromosomes (I think). Both tests are used on day 5 blasts, and then the embryos are vitrified (special freezing technique) until you get your tests back in about 6 weeks and do an FET. This is my even more simplified version of Dr. BloSunMyCha's layman's version, so I'm sure I'm not entirely explaining this well.

The catch is that you have to have ten embryos on Day 1 or ten fertilized eggs. At my age, it's doubtful I will meet that criteria. I was happy to have six embryos on day three last time. The other alternative is to do Polar Body Testing, which is done on day 1, but it only tells you about the genetics of the egg, and not the embryo. Polar Body Testing also has a much lower pregnancy rate of 20 to 30% compared to 80% for CGH or microarray.

The other catch is that BigShotClinic does not do sex selection. They basically transfer back the best embryos, regardless of sex, and they do not tell you the sex until after they transfer them. I didn't ask exactly when they tell you the sex, but I'm sure it would be sometime after a positive beta. If they have normal and excellent quality embryos of the sex you prefer, they will put them back.

Waaay back when we had our first serious talk about baby making with my third RE after my surgery, we discovered a sperm selection program for gender called Micro_Sort. However, I did not meet the age criteria, which was 38 and younger at the time. I think I was 39 at the time. My research from last night shows they upped the age limit to 39. Bottom line: if you are "old" you take what you get. Can you say age discrimination?

Dr. BloSunMyCha recommended 3-day transfer with us, which I am fine with, but he recommended putting back four to six embryos at my age. This does not make me happy. I do not want to risk multiples again. Pregnancy rate for my age is 35% at BigShotClinic, with still a 20% chance of twins. The stats are not good, but considering that what happened to us last time was very low statistically, then maybe I still have a chance.

All I know is that I feel crappy about all this. I hate not knowing what to do. I hate taking a huge gamble on money we don't have. I hate not going through all this high tech process of getting pregnant, and then not having choices about it. I hated it then, and I hate it now. The only good thing that came out of yesterday is I got a pass on the Clomid challenge test. The rest will have to wait for another post.

I don't know whether this is helpful but my understanding is that you can do CGH or Microarray at your clinic at your risk without any cut-off. I've just cycled at what I think is your clinic (except I have a Doctor S) and we are doing microarray on our 3 fertilised embryos that miraculously all went to blast. They agreed in advance that as long as we understood and accepted the risk that we may have nothing to test (ie: no fertilised eggs go to blast) that we could do this form of genetic testing. We are bundling - ie: going to another retrieval pre transfer, but I don't believe that changes the principle. Just letting you know in case you do decide to purse this route and wishing you the very best xxx

Well that explains why we never even got a mention of genetic testing--we don't make many embryos period. Sigh. Even with an FSH of 5. But this isn't about me.I'm sorry you are in this place at all...I know it's hard. I wish it wasn't.Wishing you an easy decision about next steps.

But it still sounds so crazy and confusing. It's like they're asking for so much and yet you have very little say in the whole matter.

maybe the problems here are more philosophical than chemical? what do you realy want? what is really important here? and adding to the sucks-factor is the problem of $$ where you don't have that much freedom to experiment and see.

sending you love and hugs. i wish the chocoloate would work and just melt all your troubles away! it works great for me ;)-

I did know that they wouldn't do sex selection. I thought it was interesting of them and I guess it makes sense. Never really thought about it at all. Also - I had no idea that you had to have 10 embies to start!

However, on another note, I did 5 local IVF's (which were ridiculous b/c my old RE was a MESS) and 1 fresh IVF at CCRM, we put back in 4 "perfect" day 3 embies and 1 did stick for about 9 weeks. That was painful- but it was also the most success we have had. Dr. G is good. I totally trust him. I just insisted on testing this time b/c I wanted to lower my chances of another m/c.

This is alot to think about. I'm sorry it is so hard. Just know that you are in good hands. (Oh, and I am still really suprised about that 10 egg req't - I'd post on IVFC and see if that is really the case- I don't actually think so).